Improving Psychosocial Outcomes Among Informal Caregivers in Low-and Middle-Income Countries: A Systematic Review of Intervention Studies

Background: Informal caregivers, primarily family members, are crucial in supporting individuals with chronic illness, disability, or age-related frailty, particularly in low- and middle-income countries (LMICs), where formal care infrastructure is limited. Caregivers in these contexts often face significant psychological distress, caregiving burden, and limited access to support. Although interventions to address these challenges are increasingly common in high-income settings, little is known about the effectiveness of these interventions in LMICs. Thus, to fill this knowledge gap, this systematic review answered the following questions: 1) what are the most common types of interventions and outcomes targeting informal caregivers in LMICs; 2) what is the methodological rigor of the studies, and 3) what types of interventions demonstrated the strongest evidence when considering the methodological rigor of the studies?

Methods: Following PRISMA guidelines, a systematic search was conducted across 13 academic databases. Inclusion criteria were: (1) quantitative intervention studies with a treatment and control group; (2) interventions targeting informal or unpaid family caregivers; (3) conducted in LMICs as defined by the World Bank; and (4) publications in English from 2001–2025. An adapted 11-item Methodological Quality Rating Scale (MQRS) was used to assess the methodological quality of the studies, with total scale scores ranging from 0 to 14. Studies scoring at or above the median were rated as “high rigor” and those below the median as “low rigor”. Intervention effectiveness was classified as strong (significant outcomes and high rigor), promising (significant outcomes and low rigor), or weak (non-significant outcomes and low or high rigor).

Results: Fourteen studies, all RCTs, met the inclusion criteria. The most common outcomes were psychosocial wellbeing (n=8) (e.g., caregiver stress, anxiety, depression, self-efficacy) and caregiver knowledge (n=6) (e.g., caregiving knowledge, feeding, communication skills). Interventions were categorized by model (psychosocial vs educational) and interventionist (specialist vs non-specialist). The MQRS median score was 12.5 (SD=8.86). Study design and theoretical foundations were areas of methodological strengths, while follow-ups and statistical power were areas that required improvement.

For psychosocial outcomes, when assessing intervention effectiveness, all five specialist-delivered interventions (100%) yielded significant results, with high rigor (i.e. strong evidence). For non-specialist-delivered interventions, 2 of 3 (67%) demonstrated strong evidence, and 1 of 3 (33%) was promising. Comparing intervention models, 75% of psychosocial-behavioural interventions (6 of 8) demonstrated strong evidence of effectiveness, while only 16.7% of educational interventions (1 of 6) was rated strong, with three showing promise, although (5 of 6) had significant outcomes.

Regarding caregiver knowledge, 67% of both specialist- and non-specialist-delivered interventions showed significant results, yet because rigor was low, evidence was rated as promising. Comparing intervention models, 83% of educational interventions were significant, but most were rated promising due to lower methodological rigor.

Conclusions and Implications: Psychosocial-behavioural interventions and specialist-delivered interventions show the strongest evidence for reducing psychosocial distress among caregivers. Educational interventions, although promising for enhancing caregiving knowledge, often lack methodological rigor. Future research should focus on increasing methodological rigor by improving follow-ups and statistical power of samples to strengthen the evidence base for informal caregiver interventions in LMICs.